Community Mental Health Center Certification
A provider is required to complete one CMHC application in the DMHA Provider Portal. CMHCs are required to complete an Addiction Service Provider-Regular certification for each location that is providing services under the CMHC umbrella. This is a requirement for providing the continuum of care. If SUD services are being contracted out to another entity, the CMHC should provide that contract in their application. Please note that the contract should be specific in identifying what locations and services this entity is covering. Those entities will be required to have an Addiction Service Provider certification to be in compliance.
A provider who has an area with services for the following six (6) areas of treatment and prevention of mental disorders:
- Inpatient services
- Residential services
- Partial hospitalization services
- Outpatient services
- Consultation-education services
- Community support services
A provider must be compliant with the following Indiana Administrative Code:
- 440 IAC 4
- 440 IAC 4.1
- 440 IAC 9
Completing the application in the DMHA Provider Portal, you will be asked to provide the following information via rich text:
- Policies and Procedures for application in DMHA Provider Portal (Note: these are required to be entered as rich text.)
- IC 12-27
- IC 16-39
- Copy of each MOU or contract that the agency has with entities that are providing continuum of care services
- Contracted For-Profit CEO Statement-
- If the CMHC is contracting with a for-profit entity to provide any services that may be contracted out per Indiana Administrative Code, they are required to upload the MOU with that entity, as well as a statement on CMHC letterhead that neither entity is profiting off the relationship. It must be signed by both entities.
- In the CMHC is NOT contracting with a for-profit entity to provide any services that may be contracted out per Indiana Administrative Code, then the CMHC needs to upload on letterhead that no such relationship exists.
- Copy of accreditation letter, copy of full accreditation report, the accrediting body’s survey recommendations and your response to the recommendations from a Division approved accrediting body. OR if your program is not yet accredited, provide proof that an application for accreditation has been submitted and accepted by a Division approved accrediting body.
- Medical Director License
- Most recent financial audit
- Proof of liability insurance
- List of governing board (at least 5 members, 1 should be licensed)
- County the member represents
- Full address of member
- Telephone number(s) of members
- Email address of members
- A written, signed and dated statement verifying consumer representation as required by 440 IAC 4.1-2-2 (c) (2).
- Consumer representative name should not be included
- Providers will be required to provide the following subtotals for Direct Care Staff (Psychiatrists, Licensed Psychologists (including HSPP), LCAC, LCSW, LMHC, LMFT, CNS, APN, and All Other Direct Care Staff:
- Number of Agency Staff FTEs
- Number of Contract Staff FTEs
- Total Number of FTEs